Welcome to my blog. HIV prevalence is not a reliable indicator of sexual behavior because the virus is also transmitted through unsafe healthcare, unsafe cosmetic practices and various traditional practices. This is why many HIV interventions, most of which concentrate entirely on sexual behavior, have been so unsuccessful.

Friday, September 14, 2012

I went to a village in Western Kenya earlier this week because someone I'm in touch with said there was a young man there who had been forcibly circumcised by a mob who claimed to be 'kicking AIDS out of Kenya'. I also had a video camera, as someone else wants filmed interviews about circumcision. I felt so bad for the young man who had undergone forcible circumcision that I wondered what right I had to film him and ask him to tell his story. But what he experienced, though extreme, is just one partial consequence of the current received view that circumcision reduces HIV transmission.

Most tribes in Kenya practice circumcision and an estimated 85% of men are circumcised for cultural reasons, rather than for any claimed hygiene or disease reduction reasons. But some do mention hygiene and disease reduction, especially HIV and sexually transmitted infections, when asked. However, the Luo, a large tribe, along with several smaller tribes, do not circumcise. The village I visited is mainly inhabited by people who are circumcised. There are Luos and others who are not circumcised, but they are in a minority everywhere except in part of Nyanza and perhaps a few slum areas in Nairobi (they can also be found close to Lake Victoria in Tanzania and Uganda).

The young man who underwent forcible circumcision was from a small tribe that does not circumcise. However, during circumcision month, which was August, some people apparently decided that they would circumcise him. As the incident only happened four weeks ago, the man was visibly upset and also said he was still in pain. He started to relate his story, with someone translating from the Luhya language into English. But when he got to the bit about being circumcised, he said he couldn't continue. His cousin, who witnessed the whole event, told the story instead, in Kiswahili, with a translator.

Forcible circumcisions do occur, but sometimes the target is a member of a circumcising tribe who has not been circumcised. But other times, the victim is a member of a non-circumcising tribe. This sort of violence has been said to have been carried out during the post-election violence in 2008, and on various other occasions over the years. The man I spoke to, though, was not just a victim of forced circumcision. The mob beat him, stripped him in public, humiliated him, marched him several kilometers naked, stole everything he had and then left him to fend for himself.

He was brought to the river where traditional circumcisions take place and covered in mud, apparently the usual practice in the area. On the way, some of the mob collected money from passers by on the road. It is said they collected about 15,000 Kenyan shillings, more than $150, which would represent many months of wages. It is customary for the circumcised youth to be given money for their coming of age, so many people contributed. But that money, also, was stolen. In other incidents, the mob has taken the victim to hospital and even paid for treatment. But in this case, this was not done.

The current enthusiasm in the HIV industry to get as many Africans as possible to agree to be circumcised did not 'cause' the above incident. It simply gave the mob another excuse for what was an extremely violent act, involving a number of crimes, none of the which the police are investigating. But does that mean the mass male circumcision programs do not involve violence? Perhaps it could be argued that they don't involve violence, but they do involve aggressively selling an invasive operation that it is well known will have little positive impact on HIV transmission at a population level, and may even have a negative impact.

The mass male circumcision program or 'voluntary medical male circumcision' as it's called (VMMC), amounts to an attack on the rights of men to decide whether to be circumcised or not; an attack, because men are not being given clear and accurate information. They would be shocked to know that appropriate penile hygiene would give them better protection from HIV; some would even be shocked to hear that they will still have to use condoms. But even the HIV industry knows well that VMMC will have little impact. So why are they so keen to spend lots of money on this program, at the expense of cheaper programs that will benefit more people?

Ironically, much of the negative impact may be more noticeable in the circumcising tribes than in the currently non-circumcising tribes. If you talk to people who currently circumcise, they will tell you that they don't need condoms, even that condoms don't work. They will tell you that they are protected from HIV. Some will qualify that and say they are partially protected, but many will not. They are not being targeted by the VMMC campaigns, which claim to be enforcing the message about partial protection.

Women also may suffer more than men from the negative impacts of the campaigns. They are not being consulted, but also, it is likely that circumcision will increase transmission from men to women. It is only claimed to reduce transmission from women to men, which makes up a smaller proportion of all transmissions, about 40% in Kenya. But many women think, or believe it when they are told, that circumcised men are less likely to be HIV positive and that there is less need for them to use condoms.

I can't help thinking that Kenyans and other Africans are being tricked, just as they have been lied to and abused by the HIV industry since the beginning of the HIV epidemic. Mass circumcision seems to be a physical attack by a group of well funded international institutions on entire cultures, between 22 and 38 million Africans, it has been estimated. The HIV industry appears to be putting the (American) culture of male circumcision forward as being superior to cultures where male circumcision is not practiced. The forcible circumcision described above is sickening, but the number of victims of VMMC, men, women and children, sound as if it would fit the definition of a crime against humanity.

Perhaps it's too strong to use the explicit term 'crime against humanity', I don't know. Those pushing the VMMC campaign don't look like an angry mob, beating and stealing from the victim. But they have financial and political strength, coupled with the sometimes violent support of some of the circumcising tribes. The Luo are politically weak, internationally and in Kenya. The Luo Prime Minister, Raila Odinga, and some other Luo politicians have apparently agreed to be circumcised to promote the campaign. But was this for the sake of their fellow Luos or for the sake of their own careers, after generations of being told that an uncircumcised man is not fit to run the country?

Of course, circumcision is not exclusive to American culture. But almost all the money behind VMMC is from the US. Many of the arguments appear to be based on the sort of American prudishness about sex and hygiene, especially sex and hygiene among Africans, that has driven the bulk of 'philanthropy' for much of the 20th century, continuing up to the present day. The programs are even being carried out by organizations that have roots in eugenics, 'social hygiene', population control and various other notions that differ little except in terminology. This theme will be continued in the next few days.